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Angiography After Cardiac Arrest — EECC MCQ

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HardGeneral CardiologyAngiography After Cardiac ArrestEECC

A haemodynamically stable survivor of out-of-hospital VF arrest has no ST elevation, no ongoing chest pain and no shock. Echocardiography shows mild global dysfunction. What is the best coronary strategy?

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Correct answer: B — Use selective rather than routine immediate angiography

Trials in stable cardiac-arrest survivors without ST elevation have not shown benefit from routine immediate angiography compared with a delayed or selective approach. Ongoing ischaemia, shock, electrical instability or high suspicion of an acute occlusion can justify urgent invasive assessment. Otherwise, stabilisation, neurological care and systematic evaluation of coronary and non-coronary causes are appropriate. The original answer incorrectly mandated urgent angiography for all survivors, ignoring contemporary evidence and the essential haemodynamic distinctions.

Reference: 2023 ESC Guidelines for acute coronary syndromes. https://www.escardio.org/guidelines/clinical-practice-guidelines/all-esc-practice-guidelines/acute-coronary-syndromes/